The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease

INTRODUCTION: We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone....

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Autores principales: Cordovilla, Rosa, López-Zubizarreta, Marco, Velasco, Antonio, Álvarez, Alberto, Rodríguez, Marta, Gómez, Asunción, Hernández-Mezquita, Miguel Ángel, Iglesias, Miguel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613614/
https://www.ncbi.nlm.nih.gov/pubmed/34950670
http://dx.doi.org/10.1159/000519034
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author Cordovilla, Rosa
López-Zubizarreta, Marco
Velasco, Antonio
Álvarez, Alberto
Rodríguez, Marta
Gómez, Asunción
Hernández-Mezquita, Miguel Ángel
Iglesias, Miguel
author_facet Cordovilla, Rosa
López-Zubizarreta, Marco
Velasco, Antonio
Álvarez, Alberto
Rodríguez, Marta
Gómez, Asunción
Hernández-Mezquita, Miguel Ángel
Iglesias, Miguel
author_sort Cordovilla, Rosa
collection PubMed
description INTRODUCTION: We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone. MATERIAL AND METHODS: A retrospective study of the prospective database collected on the patients with NSCLC with a radiologically normal mediastinum and an indication for systematic staging with EBUS and EUS. EBUS staging was followed by EUS in patients in which the results from the pathological analysis of EBUS were negative. RESULTS: Forty-five patients were included in the analysis. The combination of EBUS followed by EUS provided better results than EBUS alone: sensitivity (S) 95% versus 80%, negative predictive value (NPV) 96.15% versus 86.21%, negative likelihood ratio 0.05 versus 0.20, and post-test probability 3.8% versus 13.8%. This represents an increase in S (15%), the validity index (6.6%), and NPV (9.9%) compared to EBUS alone. There were 4 false negatives (FNs) (8.8%) with the EBUS test alone. After adding EUS, 3 more cases were positive (6.6%) and only 1 FN (2.2%). CONCLUSIONS: In patients with NSCLC and a radiographically normal mediastinum, a systematic and combined staging with EBUS and EUS show higher sensitivity in the detection of mediastinal metastasis than with the use of EBUS alone. The high accuracy of the test means that the use of mediastinoscopy is not necessary to confirm the results in these patients. Since the availability of EUS is low, it may be advisable for the interventional pulmonologist to receive training in EUS-b.
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spelling pubmed-86136142021-12-22 The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease Cordovilla, Rosa López-Zubizarreta, Marco Velasco, Antonio Álvarez, Alberto Rodríguez, Marta Gómez, Asunción Hernández-Mezquita, Miguel Ángel Iglesias, Miguel Biomed Hub Research Article INTRODUCTION: We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone. MATERIAL AND METHODS: A retrospective study of the prospective database collected on the patients with NSCLC with a radiologically normal mediastinum and an indication for systematic staging with EBUS and EUS. EBUS staging was followed by EUS in patients in which the results from the pathological analysis of EBUS were negative. RESULTS: Forty-five patients were included in the analysis. The combination of EBUS followed by EUS provided better results than EBUS alone: sensitivity (S) 95% versus 80%, negative predictive value (NPV) 96.15% versus 86.21%, negative likelihood ratio 0.05 versus 0.20, and post-test probability 3.8% versus 13.8%. This represents an increase in S (15%), the validity index (6.6%), and NPV (9.9%) compared to EBUS alone. There were 4 false negatives (FNs) (8.8%) with the EBUS test alone. After adding EUS, 3 more cases were positive (6.6%) and only 1 FN (2.2%). CONCLUSIONS: In patients with NSCLC and a radiographically normal mediastinum, a systematic and combined staging with EBUS and EUS show higher sensitivity in the detection of mediastinal metastasis than with the use of EBUS alone. The high accuracy of the test means that the use of mediastinoscopy is not necessary to confirm the results in these patients. Since the availability of EUS is low, it may be advisable for the interventional pulmonologist to receive training in EUS-b. S. Karger AG 2021-10-08 /pmc/articles/PMC8613614/ /pubmed/34950670 http://dx.doi.org/10.1159/000519034 Text en Copyright © 2021 by S. Karger AG, Basel https://creativecommons.org/licenses/by-nc/4.0/This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.
spellingShingle Research Article
Cordovilla, Rosa
López-Zubizarreta, Marco
Velasco, Antonio
Álvarez, Alberto
Rodríguez, Marta
Gómez, Asunción
Hernández-Mezquita, Miguel Ángel
Iglesias, Miguel
The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_full The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_fullStr The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_full_unstemmed The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_short The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_sort value of a systematic protocol using endobronchial ultrasound and endoscopic ultrasound in staging of lung cancer for patients with imaging in0–n1 disease
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613614/
https://www.ncbi.nlm.nih.gov/pubmed/34950670
http://dx.doi.org/10.1159/000519034
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